Healthcare Provider Details

I. General information

NPI: 1619193273
Provider Name (Legal Business Name): ANDREW BRUCE FISHER PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5665 COLLEGE AVE SUITE 340A
OAKLAND CA
94618-1625
US

IV. Provider business mailing address

237 PARK VIEW AVE
PIEDMONT CA
94610-1041
US

V. Phone/Fax

Practice location:
  • Phone: 510-547-6223
  • Fax: 510-420-0888
Mailing address:
  • Phone: 510-658-5363
  • Fax: 510-658-5398

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TP0016X
TaxonomyPrescribing (Medical) Psychologist
License NumberPSY9638
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: